Provider Demographics
NPI:1003862848
Name:ARKANSAS CARDIOLOGY
Entity Type:Organization
Organization Name:ARKANSAS CARDIOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:HARDAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-227-7596
Mailing Address - Street 1:PO BOX 3496
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72203
Mailing Address - Country:US
Mailing Address - Phone:501-227-7596
Mailing Address - Fax:
Practice Address - Street 1:9501 BAPTIST HEALTH DR
Practice Address - Street 2:STE 600
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6225
Practice Address - Country:US
Practice Address - Phone:501-227-7596
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR57017OtherBLUE CROSS BLUE SHIELD
ARCC6745OtherRAILROAD MEDICARE
ARCN1884OtherRAILLROAD MEDICARE
AR57017Medicare PIN